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PubMed2001

[Incidence of symptomatic celiac disease in French children].

OBJECTIVE: The study was carried out by the GFHGNP to determine the annual incidence of symptomatic celiac disease in children. PATIENTS AND METHODS: The diagnostic criteria were: symptomatic patients diagnosed under 15 years of age during 1996, villous atrophy and positivity of antigliadin and/or other antibodies. Cases were collected from referral centers, general hospital pediatric departments and private pediatricians with endoscopic practice. RESULTS: The study involved roughly half of the French pediatric population in 41 out of the 95 French districts. In all, 124 patients were collected: 76 girls and 48 boys. By geographical areas, in 30 districts where collection of data was complete which counted 186,285 births, the yearly incidence varied from 1/1731 births to 1/3110. (0.57@1000 to 0.32@1000). On the whole there were 77 cases i.e. an annual incidence of 1/2419 or 0.41@1000 (confidence interval 95%: 0.32 to 0.50@1000). Lower incidences were observed in the district of Paris: 1/4865 (0.21@1000) and Lyon: 1/3310 (0.27@1000). Those lower incidences could be explained by the difficulties of collecting the data in the biggest urban areas. The first signs occurred before one year of age in 73% of the cases, during the second year of life in 20.5% and after 3 in only 6.5%. The diagnosis was made before 2 years of age in 77% of the cases and after 3 in only 13%. In order of frequency symptoms were: failure to thrive (80%), diarrhea (59%), anorexia (59%), abdominal distension (57%), weight under 2 standard deviations (43%), short stature (43%). CONCLUSION: Compared with previous studies in two French districts between 1975 and 1990, the annual incidence of symptomatic celiac disease in children appears to be on the rise. The usual clinical signs continue to be observed.

Adolescent↗
PubMed2006

Recent advances in the understanding of celiac disease: therapeutic implications for the management of pediatric patients.

Celiac disease (CD) is an autoimmune condition occurring in genetically susceptible individuals characterized by inflammatory injury to the mucosa of the small intestine after the ingestion of wheat glutens or related barley and rye products. Originally thought to be highly prevalent only in Northern European populations, growing evidence indicates a much higher prevalence in many other regions, including the US as well as South America, North Africa, and Asia. The growing awareness that pediatric patients may present with quite diverse and protean manifestations and the significant impact of CD on childhood development has prompted efforts to increase CD awareness for the early diagnosis and treatment of this disease. The current diagnostic criteria for CD requires characteristic histologic findings in small bowel biopsies and clinical remission when placed on a gluten-free diet. Serologic testing for CD can provide additional support for the diagnosis of CD or a means to assess efficacy and adherence to a gluten-free diet. The mainstay of treatment remains the institution of a gluten-free diet. However, patients with refractory CD may require treatment with immunosuppressant medications. With the increased identification of specific gluten epitopes and understanding of the pathogenesis of CD, future therapies may rely on genetically altering gluten proteins, immunization techniques, or therapies focused on either the development of specific immune tolerance or regulation of mucosal inflammation.

Adolescent↗
PubMed2004

Hematologic manifestation of childhood celiac disease.

We wanted to describe the hematologic manifestations of celiac disease (CD) in childhood. This study included 22 children with CD in whom the disease remained undiagnosed until they had presented with hematological abnormalities, such as anemia, thrombocytopenia, leukopenia or prolonged prothrombin time (PT) and activated partial thromboplastin time (APTT). Anemia was present alone in 19 (86.3%) patients, and leukopenia coexisted with anemia in 2 (9%) patients. Thrombocytopenia was found alone in 1 (4.5%) patient. Twelve patients had an iron deficiency anemia. Iron deficiency coexisted with zinc and vitamin B(12) deficiency in 3 patients, copper and vitamin B(12) deficiency in two, vitamin B(12) deficiency in two, zinc deficiency in two and one patient had combined iron, zinc, and copper deficiency. Males had significantly lower values of hemoglobin (p < 0.05) and MCV (p < 0.05) compared to the females. In conclusion CD should be included in the differential diagnosis in children who present with anemia, leukopenia, thrombocytopenia or prolonged PT and APTT, especially in geographical areas where the prevalence of the CD is high.

Adolescent↗
PubMed1985

Increased serum beta2-microglobulin levels in active celiac disease.

Sixty-eight sera from 36 children with celiac disease (CD) were collected in a 4-year study, and the levels of beta2-microglobulin (beta2M), orosomucoid, alpha1-antitrypsin, and C-reactive protein (CRP) were measured. A simultaneous intestinal biopsy was taken in all the patients and used to classify them. The values of beta2M were 1.94 +/- 0.49 mg/L in group A (inactive CD with normal intestinal biopsy) and 2.58 +/- 0.76 mg/L in group B (active CD with flat mucosa). These levels were higher than in the normal controls (1.87 +/- 0.49 mg/L, p less than 0.005) and in the other 19 patients with chronic diarrhea of another cause (1.72 +/- 0.63 mg/L, p less than 0.005). CRP values were generally normal; orosomucoid and alpha1-antitrypsin were variable and they did not correlate with beta2M levels. Beta2M was increased at the time of diagnosis in seven of eight (87.5%) of the CD children and only in three of 19 (15.7%) of nonceliac patients with chronic diarrhea of another cause (p less than 0.005). In 12 children with CD, serial studies were possible. The highest beta2M level coincided with a flat mucosa in 10 cases. The increase of beta2M could be related to the intestinal infiltration or even to the lymphocyte activation. It may also be a useful noninvasive method for evaluating the activity of CD.

Acute-Phase Proteins↗
PubMed1995

Body composition and bone mineral density in untreated and treated patients with celiac disease.

Body composition and bone mineral density (BMD) were studied by X-ray absorptiometry in 20 untreated and 12 treated women with celiac disease, as well as in 85 age-matched control women. Untreated patients had a significantly lower body weight, fat mass, lean tissue mass and BMD at the lumbar spine and total skeleton compared to controls (p < 0.001 for all parameters). Treated patients had also a significantly lower body weight (p < 0.01) fat mass (p < 0.05) and bone mineral density at lumbar spine and total skeleton (p < 0.05) compared with controls, but lean tissue mass was not diminished. However, treated patients had a significantly higher body weight, fat mass and BMD of the total skeleton compared with untreated celiac patients (p < 0.01 for all parameters). Serum alkaline phosphatase levels were increased in untreated patients but serum 250HD was normal. In conclusion, celiac disease causes a global and almost universal reduction of fat mass and BMD. The results of this cross-sectional study suggest that osteopenia does not seem to be completely restored by adequate treatment. Alteration of vitamin D metabolism was not the cause of osteopenia in the majority of patients.

Absorptiometry, Photon↗
PubMed2001

Prevalence of silent celiac disease in patients with autoimmune thyroiditis from Northern Sardinia.

Celiac disease (CD) is frequently associated with other autoimmune diseases such as Type 1 diabetes mellitus, autoimmune thyroiditis (AT), and Addison's disease. The frequency of these associations varies with the populations studied. We conducted this study to ascertain the prevalence of CD in patients with AT from Sardinia, an area with a very high prevalence of CD. To this aim, 297 consecutive patients with AT (as defined by elevated antithyroid antibody levels and a positive ultrasound scan) were studied. Immunoglobulin A and G-class antigliadin antibodies were assayed in serum; if either or both were positive, antiendomysium antibodies were determined. If two markers were positive, serum ferritin, folate, and vitamin B12 levels were measured and jejunal biopsy was suggested. Thirteen out of the 14 patients who showed at least two positive markers consented to jejunal biopsy and all of them showed histological features of CD. The prevalence of CD in AT patients was 4-fold greater than that observed in the general population (4.37 vs 1.06%, p<0.0001). Ferritin was low in 6 and vitamin B12 in 2 out of 13 patients; serum folates were normal in all patients. Molecular typing of HLA class II alleles showed an increased frequency of the extended haplotype DRB1*0301/DQA1*0501/DQB1*0201. None of our patients had a history of gastrointestinal symptoms. We confirm the increased prevalence of silent CD in patients with AT. Patients with AT ought to be regarded as a high-risk group for CD and should be screened routinely for it; if negative, screening tests should be repeated at regular intervals.

Adolescent↗
PubMed1995

Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet.

OBJECTIVES: To investigate the effect of gluten-free diet on mineral and bone metabolism in women with celiac disease and, using the strontium test, to assess intestinal calcium absorption. METHODS: We studied body mass index, biochemical and bone mineral indices, strontium absorption test, and bone mineral density in 18 women (mean age 36.8 yr, range 18-68 yr) with celiac disease at diagnosis and after 12 months of gluten-free diet. RESULTS: Mean strontium absorption at diagnosis was markedly decreased with respect to control values (13.84 +/- 9.03% vs 22.47 +/- 4.21%, p < 0.0001), and 11 of the 18 patients (61%, subgroup A) had low values. In all patients, mean hemoglobin, serum potassium, magnesium, plasma calcium, urinary calcium, and phosphorus were significantly abnormal at diagnosis, whereas only the subgroup A had significantly reduced body mass index, 25 OH vitamin D, and elevated alkaline phosphatase. This subgroup differed in body mass index (p < 0.003) and calciuria (p < 0.035) with respect to the other patients. Strontium absorption correlated with body mass index, calcemia, and 25 OH vitamin D. After the gluten-free diet, all biochemical variables and strontium absorption normalized (23.23 +/- 5.54%), whereas bone mineral density did not change. CONCLUSIONS: At diagnosis, the patients frequently had intestinal calcium malabsorption, as demonstrated by strontium test, with an early renal compensatory mechanism. After the gluten-free diet, the normalization of calcium absorption and the decrease of mid-molecule parathyroid hormone suggested a normalization of mineral metabolism, although a positive effect on bone mineral density was not evident at that time.

Adult↗
PubMedDate not supplied

Malakoplakia of colon in a child with celiac disease and chronic granulomatous disease.

Malakoplakia is a rare pseudotumoral inflammatory disease known to affect immunocompromised subjects. We report a 4-year-old boy with malakoplakia of colon who was diagnosed with celiac disease in late infancy; despite aggressive nutritional and medical management for celiac disease, symptoms did not resolve. His nitro-blue-tetrazolium test was compatible with chronic granulomatous disease. In colonic biopsy Michaelis-Gutmann bodies were seen.

Celiac Disease↗
PubMed2004

Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.

OBJECTIVE: To determine whether undiagnosed celiac disease is associated with irritable bowel syndrome (IBS) or dyspepsia in the community. SUBJECTS AND METHODS: A self-report bowel disease questionnaire was mailed to a random sample of Olmsted County, Minnesota, residents aged 20 to 50 years. All respondents who reported symptoms of dyspepsia or IBS (cases) and all respondents without notable gastrointestinal symptoms (controls) were invited to participate (260 eligible subjects; 150 [58%] were studied). Each respondent was examined by a physician, and the medical records of each were reviewed (3 subjects did not meet the criteria for dyspepsia or IBS at the time of the physician interview). Serum was obtained to measure antiendomysial antibodies and tissue transglutaminase (TTg) IgA antibodies using validated assays. RESULTS: A total of 34 subjects had dyspepsia (20 had ulcerlike dyspepsia), 50 had IBS (19 had diarrhea-predominant IBS), and 15 met criteria for both dyspepsia and IBS; 78 were asymptomatic healthy controls. The overall prevalence of positive TTg serology was 4% (95% confidence interval [CI], 1.5%-8.5%). The number of subjects who were seropositive for TTg was 2 of 34 (5.9%) with dyspepsia (95% CI, 0.7%-19.7%), 2 of 50 (4.0%) with IBS (95% CI, 0.5%-13.7%), and 2 of 78 (2.6%) of asymptomatic controls (95% CI, 03%-9.0%) (P = .64 IBS vs controls; P = .58 dyspepsia vs controls). No subjects had positive antiendomysial antibodies. CONCLUSION: In this community, celiac disease did not explain the presence of either IBS or dyspepsia.

Adult↗
PubMed1989

Intestinal permeability assessed with different-sized polyethylene glycols in children undergoing small-intestinal biopsy for suspected celiac disease.

The gastrointestinal permeability was assessed by means of an oral load of a mixture of different-sized polyethylene glycols (PEG 400 and PEG 1000) in 76 children undergoing small-intestinal biopsy because of suspected celiac disease. Children with a mucosal abnormality suggestive of celiac disease had a lower urinary recovery of larger PEG molecules. They also displayed an altered permeability barrier, as evidenced by a lower ratio of recovery between large (1074 Da) and small (370 Da) PEG molecules. Gluten elimination and gluten challenge caused a significant change in PEG recoveries in children undergoing repeated PEG tests. Repeated assessments of intestinal permeability by means of different-sized PEGs after gluten withdrawal and challenge could complement or indicate suitable time for performing small-intestinal biopsy in children with gluten intolerance.

Adolescent↗
PubMed1995

Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study.

The validity of pancreatic enzyme substitution therapy in the two months following diagnosis of celiac disease was investigated. Twenty patients (8 males, 12 females), mean age 14.2 months (group A) received an enzyme substitution preparation. The control group (group B) included 20 patients (9 males, 11 females), mean age 14.5 months, treated with placebo. Before starting treatment, we performed a stratification for age, weight-for-age at diagnosis, and degree of pancreatic insufficiency. The therapies were then administered randomly in double-blind fashion. On diagnosis and 30 and 60 days after commencement of a gluten-free diet with identical calorie intake in both groups, a series of anthropometric variables were determined. After 30 days weight increase in group A patients was significantly higher (in grams) than in group B: 1131 +/- 461 vs 732 +/- 399 (P < 0.006). Weight-for-age increase also was greater in group A than in group B: 9.2 +/- 5.1% vs 5.0 +/- 4.0% (P < 0.002). The increase in height Z score, weight-for-height, arm circumference, and subscapular and tricipital fold measurements were greater in group A patients than those in group B, but the difference was not significant. After 60 days of therapy none of the parameters considered were significantly different in the two groups. We concluded that pancreatic enzyme therapy is certainly useful in the first 30 days after diagnosis of celiac disease.

Celiac Disease↗
PubMed1987

Effect of gluten supplementation in healthy siblings of children with celiac disease.

The clinical, functional, and histopathological effects of 18 g additional gluten intake daily for 4 wk was studied in 13 healthy siblings of Spanish children with celiac disease, including two pairs of discordant monozygotic twins. Five of the 13 children were HLA-DR identical to the celiac sibling, 5 shared only one HLA-DR antigen with the celiac sibling, and 3 had completely different HLA-DR antigens than their respective celiac brothers or sisters. Clinical evaluation and functional tests (routine blood, xylose absorption, and fecal fat excretion studies) were performed before, during, and after gluten challenge. A jejunal biopsy specimen was taken at the end of the 4-wk period of gluten supplementation. No clinical abnormalities were found during the period of the study and there was no significant decrease of xylose absorption. Fecal fat excretion studies gave normal results, both before and after gluten challenge. The high gluten diet did not lead to histopathologic abnormalities in any of the jejunal biopsy specimens, which showed a normal range of crypt to villus ratio and surface-cell height. The present results do not support the view that excessive gluten intake is toxic for individuals who are genetically predisposed but do not have overt celiac disease. The findings also suggest that other factors besides HLA-DR antigens and gluten intake are important for expression of the disease.

Biopsy↗
PubMed1997

[Large granular T-cell lymphocytic leukemia disclosed by bilateral uveitis: association with celiac disease].

A 70-year-old woman presented with bilateral anterior uveitis. She was on a gluten-free diet because of a celiac disease which had been diagnosed 3 months before. An anterior chamber aspirate contained a majority of large granular lymphocytes (LGL). The investigation of a chronic neutropenia led to the diagnosis of an otherwise typical T-LGL leukemia. This seems to be the first report of a CD3+ CD4- CD8+ T-LGL leukemia causing anterior uveitis through infiltration of leukemic cells, and the second report of an intriguing association of celiac disease with T-LGL leukemia.

Aged↗
PubMed2004

Celiac disease diagnosis in patients with giardiasis: high value of antitransglutaminase antibodies.

OBJECTIVES: The main objective of this study is to assess the presence of celiac disease (CD) in patients with giardiasis and to evaluate the tools for diagnosis of CD in these patients. METHODS: A total of 40 patients with giardiasis were evaluated. Celiac disease was confirmed or discarded by intestinal biopsy and serological markers. Antigliadin antibodies were determined by ELISA and antitransglutaminase antibodies by one-step immunochromatographic assay and ELISA. RESULTS: Out of the 40 patients with giardiasis 37 showed normal intestinal mucosa. In this group, IgA antibodies to gliadin were positive in 7 patients, yielding a specificity of 82%. All of them were negative for transglutaminase antibodies by the immunochromatographic assay and by ELISA (specificity of 100%). The remaining 3 patients showed a subtotal intestinal villous atrophy consistent with CD, however, only two presented IgA antibodies to transglutaminase and gliadin. CONCLUSIONS: Due to its low specificity antigliadin antibodies are not useful for the screening of CD in patients with giardiasis. On the other hand, antitransglutaminase antibodies are highly specific and sensitive. One-step immunochromatographic assay is an easy and economic alternative. The findings of villous atrophy must be supported by other markers of CD to achieve the diagnosis of CD in these patients.

Adolescent↗
PubMed1989

[One hour xylose test blood in the diagnosis of celiac disease].

Plasma levels of d-xylose one hr after a standard 5 g oral dose were measured in 82 children suspected of having celiac disease. Duodenal mucosa was obtained by intestinal biopsy in all. Among patients with normal mucosa, 95% had xylose levels above 20 mg/dl; 100% of patients with a flat mucosa had levels under 20 mg/dl. Results were independent of patients age. We conclude that this is a reliable test to screen patients suspected of having celiac disease, prior to intestinal biopsy.

Adolescent↗
PubMed2004

Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease.

This study shows a broad analysis of gynaecological and obstetrical disturbances in patients with celiac disease in relation to their nutritional status and adherence to a gluten-free diet. Seventy-six adult celiac patients were analyzed according to nutritional status and 18 children/adolescents to gluten-free diet adherence. As controls, 84 adults and 22 adolescents with irritable bowel syndrome were used The significant findings were observed as follow: adult celiac patients, irrespective of the nutritional status, were younger than controls, presented delayed menarche, secondary amenorrhea, a higher percentage of spontaneous abortions, anemia and hypoalbuminemia. No differences were observed regarding the number of pregnancies, age at menopause and duration of the reproductive period. After treatment, patients presented with normal pregnancies and one patient presented spontaneous abortion. The adolescents who were not adherent to gluten-free diet presented delayed menarche and secondary amenorrhea. In conclusion, gluten per se could explain the disturbances and malnutrition would worsen the disease in a consequent vicious cycle. Therefore, celiac disease should be included in the screening of reproductive disorders.

Abortion, Spontaneous↗
PubMed1982

Serum ferritin levels in celiac disease.

Of the various common assayed parameters of iron metabolism, serum ferritin levels are the most discriminatory in distinguishing between non-treated celiac disease and other gastrointestinal disorders in the pediatric age group. Patients on normal diets usually have very low ferritin levels that increase at an average rate of 1 microgram/1/month when placed on a gluten-free diet. When the patient returns to a normal diet, however, ferritin levels decrease rapidly at an average rate of about 4 microgram/1/month. There is a relationship between abnormal intestinal changes and low ferritin levels in celiac disease with improvement in both when the patient is on a gluten-free diet. It is suggested that serial blood ferritin evaluations together with the leukocyte migration inhibition factor production assay should eliminate the need for invasive intestinal biopsies for the confirmation and possible follow-up to response to treatment.

Adolescent↗
PubMed1996

Polymyositis, arthritis, and proteinuria in a patient with adult celiac disease.

A 37-year-old woman developed polymyositis and arthritis concomitantly with proteinuria and watery diarrhea. Repeated duodenal biopsies and serological evaluation established the diagnosis of adult celiac disease. Treatment with gluten-free diet resolved all clinical and laboratory abnormalities. We believe that this is the first report of adult celiac disease presenting as a multisystem disease involving kidneys, joint, and muscles.

Adult↗